OWCP DEEOIC Outreach Event Feedback Form - Supplementary Supporting Statement

Request for Approval under the “Generic Clearance for Improving Customer Experience: OMB Circular A-11, Section 280 Implementation”

(OMB Control Number: 1225-0093)

TITLE OF INFORMATION COLLECTION: Post-event customer feedback survey for Division of Energy Employees Occupational Illness Compensation(DEEOIC)outreach events.

PURPOSE OF COLLECTION: To assess customer satisfaction with and gather customer feedback from a series of DEEOIC outreach events.

TYPE OF ACTIVITY: (Check one)

[ ] Customer Research (Interview, Focus Groups)

[ X ] Customer Feedback Survey

[ ] User Testing

ACTIVITY DETAILS

1. How will you collect the information? (Check all that apply)
   
   

[ ] Web-based or other forms of Social Media

[ ] Telephone

[ X ] In-person

[ ] Mail

[ ] Other, Explain

2. Who will you collect the information from?

DEEOIC will conduct 5 outreach events. Four of the outreach events will include Employee and Survivor-Claimants and one event will be specifically for Authorized Representatives. DEEOIC stakeholders are invited to these optional events to learn more about the program and potential benefits.

3. How will you ask a respondent to provide this information?

Participants will have the option to pick up and fill out a paper customer feedback survey at the event.

4. What will the activity look like?

The survey contains 7 questions with Likert scale response option, 1 multiple choice question, and 2 open-ended questions.

5. Please provide your question list.

See attached

Please make sure that all instruments, instructions, and scripts are submitted with the request.

See attached.

6. When will the activity happen?

DEEOIC will conduct outreach events beginning in February 2023 and continuing through Fiscal Year 2024.

7. Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants?

[ ] Yes [ X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours
Stakeholders	800	5 minutes	67
Totals			67

CERTIFICATION:

I certify the following to be true:

1. The collections are voluntary;

2. The collections are low-burden for respondents (based on considerations of total burden hours or burden-hours per respondent) and are low-cost for both the respondents and the Federal Government;

3. The collections are non-controversial and do not raise issues of concern to other Federal agencies;

4. Any collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the near future;

5. Personally identifiable information (PII) is collected only to the extent necessary and is not retained;

6. Information gathered is intended to be used for general service improvement and program management purposes

7. Upon agreement between OMB and the agency aggregated data may be released as part of A-11, Section 280 requirements only on performance.gov. Summaries of customer research and user testing activities may be included in public-facing customer journey maps.

8. Additional release of data will be coordinated with OMB.

Name: Charles Bogino

All instruments used to collect information must include:

OMB Control No. 1225-0093

Expiration Date: 02/29/2024

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